Prevalence, Etiology, and Antifungal Resistance Profiles of Ocular Fungal Infections in Ghanaian Ophthalmic Patients: A Multicenter Cross-Sectional Study.

BACKGROUND AND AIMS: Ocular fungal infections are an important but often underrecognized cause of ocular morbidity, particularly in resource-limited settings. Delayed diagnosis and inappropriate treatment can lead to poor visual outcomes and increased disease burden. This study aimed to determine the prevalence, etiology, and antifungal susceptibility patterns of ocular fungal infections among patients attending three ophthalmic facilities in Ghana.

METHODS

A multicenter cross-sectional study was conducted among 248 ophthalmic patients presenting with clinically suspected ocular infections of fungal origin. Biographical and ophthalmic data were collected using a structured questionnaire. Ocular specimens were obtained and subjected to standard microbiological culture and laboratory identification of fungal pathogens. Antifungal susceptibility testing was performed against commonly used antifungal agents. Logistic regression analysis was used to evaluate associations between participants' demographic and clinical characteristics and fungal culture positivity, with statistical significance defined as p < 0.05.

RESULTS

Fungal pathogens were isolated from 9.36% of ocular specimens. Candida albicans was the most frequently identified organism. Antifungal susceptibility testing demonstrated a high level of multidrug resistance, including reduced susceptibility to amphotericin B, fluconazole, itraconazole, and terbinafine. None of the demographic or clinical characteristics examined were significantly associated with fungal culture positivity.

CONCLUSION

The findings indicate a measurable burden of ocular fungal infections in this Ghanaian ophthalmic population, with Candida species being the predominant pathogens. The observed multidrug resistance to commonly used antifungal agents raises concerns about the effectiveness of empirical treatment and highlights the need for targeted therapy based on laboratory confirmation. The absence of significant demographic or clinical predictors suggests that clinical presentation alone may not reliably identify fungal infections. Routine microbiological diagnosis, antifungal susceptibility testing, and strengthened surveillance systems are therefore essential to guide appropriate management and improve outcomes for patients with ocular fungal infections in Ghana.